JPEN J Parenter Enteral Nutr. 2022 May 28. doi: 10.1002/jpen.2416. Online ahead of print.

Riikka Gunnar ^1 2, Annika Mutanen ^2 3, Laura Merras-Salmio ^1 2, Mikko P Pakarinen ^2 3

Author information

¹Department of Gastroenterology, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

²Pediatric Liver and Gut Research Group, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland.

³Department of Pediatric Surgery, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Abstract

Background: Steatosis is a common feature of intestinal failure associated liver disease (IFALD) in adult and older pediatric patients on long term parenteral nutrition (PN). There is limited clinical data concerning steatosis in infants with short bowel syndrome (SBS). We investigated early histopathological steatosis and its association to PN.

Methods: In this retrospective study, 31 SBS patients had a diagnostic liver biopsy taken at median age of 5 (IQR 3-8) months. Follow-up biopsy was available for 24 patients at the median age of 29 (IQR 14-52) months. We evaluated the biopsies for steatosis and other histopathological signs of IFALD and compared results with patient characteristics, PN composition and liver biochemistry.

Results: Diagnostic biopsies revealed steatosis in 8 (26%) patients. At the age of three months patients with steatosis had received higher amounts of parenteral glucose; median 15.1 (IQR 12.4-17.2) vs 12.3 (8.7-14.4) g/kg/d; P=0.04, amino acids; 2.9 (2.5-3.4) vs. 2.2 (1.6-2.7) g/kg/d; P=0.03 and energy; 87 (80-98) vs 73 (54-79) kcal/kg/d; P=0.01, than those without steatosis. We detected no significant differences in parenteral lipid intake between the groups. Steatosis associated also with increased serum bile acid (P=0.02), alanine aminotransferase (P=0.0002) and aspartate aminotransferase (P=0.001) levels.

Conclusion: In this cohort high parenteral glucose, amino acid and energy provision associated with liver steatosis in infants with SBS. We recommend monitoring of bile acid and transaminase levels while aiming for PN with balanced macronutrient supply according to current recommendations to protect the liver from steatosis. This article is protected by copyright. All rights reserved.